MEDICARE: ATLAS CHIROPRACTIC OF SYRACUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BA1441	OTHER	NY	MEDICARE PTAN

General Provider Information

NPI Number	:	1578904272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS CHIROPRACTIC OF SYRACUSE

Provider Business Mailing Address
First Line	:	141 SHOP CITY PLZ
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13206-1943
Country	:	US
Telephone Number	:	315-414-0224
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 SHOP CITY PLZ
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13206-1943
Country	:	US
Telephone Number	:	315-414-0224
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. SUZANNE TENWESTENEIND
Credential	:
Telephone Number	:	315-414-0224

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	10/29/2013

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